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Application for Proration of Property Taxes For county use only Due to Damage by Fire or Act of God Date received Oregon Revised Statutes(ORS)308.425 ! C Zu J '2t ? Instructions: •Application for proration of property taxes may be made for the tax year of the property damage/destruction.If approved,this may reduce the amount of tax due or result in a tax refund.The tax year is from July 1 to June 30. •Your application must be filed within 60 days of the damage or by June 30 of the tax year in which the damage occurred,whichever is later. •File your application with the county tax collector of the county in which your damaged property is located. Applicant's name Phone Jennifer J. Elting for PZ Elling LLC 503-690-2438 Mailing address Email(optional) 12710 SW Bowmont St j22elling@gmail.com City State ZIP code Portland OR 97225 Location and description of damaged or destroyed property Assessor's account number R58585 / 558585 Location of property(if different from above) Section Township Range Tax lot number 35364 Francis St SE 3/31) (2P L1E 0/yO0 Description of personal property Lyons,OR 97358 Date of damage Cause of damage 9/7/20 0 Fire(attach fire department report) ID Act of God(describe): catastrophic fire Damage occurred to Land El Building El Personal property 0 Manufactured structure Describe damage Home burnt to the ground including all personal property in it.Surrounding trees on the land burnt and the majority fell. Application for proration of tax El I am applying to have the above property examined for proration of property taxes per ORS 308.425.Application must be submitted within 60 days of damage or June 30,whichever is later. Whether my property is damaged or destroyed will be determined by the County Assessor's office.If the assessor determines my property is only dam- aged,I must notify the tax collector of the date that the damage is repaired.Such notice will serve to inform the tax collector of their duty to calculate and finalize the tax proration. Declaration I declare u s•- the penalt.-s for false .-aring[ORS 305.990(4)1 that I have examined this document and to the best of my knowledge it is t .-,corr-ct,and so,/plete. ,Adt 10/26/20 •.• ignature Date Ap•lic:nt will be notified of the county's decision— For tax collector's use only For assessor's use only Date received: 11-ZZ,—20 Clerk: /{" Date received: "_ t R.20 Clerk: (AJ V O(- Damaged property: This year Land and improvements: Real market value(RMV)before RMV after p Date rebuild complete: Months prorated: Lire/act of God: 2.S 21 fire/act of God: I t31 RO Assessed value(A before Value Amount of adjustment/refund. fire/act of God: 32 2 lrO percent of loss: O t 2G�1 1 Destroyed property: This year Personal property: Months prorated: (�1 RMV before RMV after fire/act of God: fire/act of God: AV before Value G�y Amount o djustmen letfe: Z 0 7•1 fire/act of God: percent of loss: Remarks: Date property visited:!I-c m-do 0 Damaged Destroyed 05f nk- rrru d 150-310-093(Rev.12-15)